右心室面积变化分数在早产儿中的临床应用

Clinical utility of right ventricular fractional area change in preterm infants.

作者信息

James Adam T, Corcoran John David, Franklin Orla, El-Khuffash Afif Faisal

机构信息

Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.

Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; Department of Paediatrics, The Royal College of Surgeons in Ireland, Dublin, Ireland.

出版信息

Early Hum Dev. 2016 Jan;92:19-23. doi: 10.1016/j.earlhumdev.2015.10.015. Epub 2015 Nov 24.

DOI:10.1016/j.earlhumdev.2015.10.015

PMID:26619069

Abstract

INTRODUCTION

Right ventricular fractional area change (RV FAC) is a novel non-invasive quantitative measure of RV function. Reference values of RV FAC and RV end systolic and diastolic areas (RVEDA, RVESA) have recently been established in preterm infants, but their role as marker to assess the efficacy of patient management strategies in the first week of life is largely unknown. The aims of this study were to assess the relationship between RV FAC and gestational age/birthweight, assess the RV FAC on day one of age to predict the later evolution of peri/intraventricular haemorrhage (P/IVH), and assess the influence of a persistent patent ductus arteriosus (PDA) on RV FAC during the first week of age.

METHODS

Preterm infants <29 weeks gestation underwent echocardiography assessments on days 1, 2 and 5-7. RVEDA and RVESA were traced in the RV-focused apical four-chamber view, and RV FAC was calculated using the formula [(RVEDA-RVESA)÷(RVEDA)] × 100. PDA treatment was not carried out during the study period. A cranial ultrasound was carried out on all infants on Days 5-7 of age. P/IVH was defined as IVH grades II to IV.

RESULTS

One hundred and one infants with a mean gestation of 26.5 (1.4) weeks and a birthweight of 983 (240) grams were enrolled in the study. There was no relationship between RV FAC and birthweight (r=-0.02, p=0.86) but there was a negative correlation between RV FAC and echo-measured SVR (r=-0.57, p<0.001). On Day 1, RV FAC was lower in infants who developed P/IVH (24% [18-34] vs. 31% [25-40], p=0.04). On Days 5-7 infants with a PDA had a lower RV FAC compared with those without [42 (7) vs. 49 (9) %, p<0.001].

CONCLUSION

RV FAC may be a useful addition to the haemodynamic assessment of preterm infants during the first week of age.

摘要

引言

右心室面积变化分数（RV FAC）是一种用于评估右心室功能的新型无创定量指标。近期已确立了早产儿的RV FAC以及右心室收缩末期和舒张末期面积（RVEDA、RVESA）的参考值，但它们作为评估出生后第一周患者管理策略疗效指标的作用尚不清楚。本研究的目的是评估RV FAC与胎龄/出生体重之间的关系，评估出生第一天的RV FAC以预测脑室周围/脑室内出血（P/IVH）的后期演变情况，并评估持续性动脉导管未闭（PDA）在出生后第一周对RV FAC的影响。

方法

对孕周小于29周的早产儿在出生第1、2以及5 - 7天进行超声心动图评估。在以右心室为中心的心尖四腔视图中描绘RVEDA和RVESA，并使用公式[（RVEDA - RVESA）÷（RVEDA）]×100计算RV FAC。研究期间未进行PDA治疗。在所有婴儿出生后第5 - 7天进行头颅超声检查。P/IVH定义为脑室内出血II至IV级。

结果

101例平均孕周为26.5（1.4）周、出生体重为983（240）克的婴儿纳入本研究。RV FAC与出生体重之间无相关性（r = -0.02，p = 0.86），但RV FAC与超声测量的体循环阻力之间呈负相关（r = -0.57，p < 0.001）。在出生第1天，发生P/IVH的婴儿RV FAC较低（24% [18 - 34] vs. 31% [25 - 40]，p = 0.04）。在出生后第5 - 7天，患有PDA的婴儿与未患PDA的婴儿相比，RV FAC较低[42（7）% vs. 49（9）%，p < 0.001]。